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Demonstration Project (demonstration + project)
Selected AbstractsGraduate Medical Education Downsizing: Perceived Effects of Participating in the HCFA Demonstration Project in New York StateACADEMIC EMERGENCY MEDICINE, Issue 2 2001Linda L. Spillance MD Abstract. Objective: Financial support for graduate medical education (GME) is shrinking nationally as Medicare cuts GME funds. Thirty-nine hospitals in New York State (NYS) voluntarily participated in a Health Care Financing Administration demonstration project (HCFADP),the goal of which was to reduce total residency training positions by 4-5%/year over a five-year period, while increasing primary care positions. The objective of this study was to determine the effect of downsizing on emergency department (ED) staffing and emergency medicine (EM) residency training. Methods: Structured interviews and surveys of NYS program directors (PDs) were conducted in October,December 1999. Simple frequencies are reported. Results: One hundred percent of 17 PDs completed the interviews and seven of 12 participants in the HCFADP returned surveys. Twelve of 17 programs participated in HCFADP and two programs downsized outside HCFADP. Seven of 12 participants lost EM positions. Six of 12 programs were forced to exclude outside residents from rotating in their ED, leading to a need for one participating program and one non-participating program to find alternative sites for trauma. Five of 12 institutions provided resident staffing data, reporting a reduction in ED resident coverage in year 1 of the project of 9-40%. Programs compensated by increasing the number of shifts worked (4/12), increasing shift length (1/12), decreasing pediatric ED shifts (1/12), decreasing elective or research time (2/12), and decreasing off-service rotations (4/12). Six departments hired physician assistants or nurse practitioners, two hired faculty, and two hired resident moonlighters. Six of 12 programs withdrew from HCFADP and returned to previous resident numbers. Eight of 12 PDs thought that they had decreased time for clinical teaching. Conclusions: A 4-5% reduction in residency positions was associated with a marked reduction in ED resident staffing and EM residency curriculum changes. [source] Nursing Outcomes for Evaluations of Caregiver Outcomes in a Rural Alzheimer Demonstration ProjectINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Janet Specht PURPOSE To evaluate the effectiveness of the interventions of nurse care managers in the care of family members of people with dementia. METHODS Data were collected as part of a 3-year Administration on Aging,funded Alzheimer Demonstration Project to provide expanded in-home services to rural Iowans affected by Alzheimer disease and related disorders in 8 rural Iowa counties,randomly selected to have a nurse care manager and 4 designated control counties that had traditional case management service. Nurse care managers were trained in the care of people with dementia and their caregivers, the use of role transition theory, and the Progressively Lowered Stress Threshold model of care to provide and coordinate services for enrollees. All referred people with cognitive impairment and their families in the 8 study counties were eligible for inclusion. Three selected NOC outcomes were tested in clinical settings. Interrater reliability for the outcomes was good (87%,95%). The construct validity of Caregiver Stressors Outcome was .74 when correlated with the Caregiver Stress Index. FINDINGS Of the 142 subjects with cognitive impairment enrolled within the first year of the grant, 113 had a caregiver. The outcomes were used to evaluate differences in caregiver outcomes at baseline and at 6-month intervals. The majority of caregivers at follow-up was female and had been providing care for ,5 years. For each of the outcomes the majority of caregivers had improved scores, with only 2,4 caregivers getting scores indicating worsening conditions or remaining the same. CONCLUSIONS Preliminary analysis shows a trend of improved outcomes with the use of a nurse care manager. The NOC caregiver outcomes showed good variability among caregivers at baseline, with caregiver responses distributed throughout the scales. The NOC outcomes also provide guidance for interventions of the nurse care managers. Further evaluation of the outcomes is needed, including examining the relationships of placement, health status, and service use of each outcome. The caregiver outcomes offer an effective and efficient means to evaluate services delivered to caregivers of people with dementia. [source] Prescribing non-psychopharmacological agents: A new potential role for psychologists in primary care settings and specialty clinicsJOURNAL OF CLINICAL PSYCHOLOGY, Issue 10 2006Jay E. Earles At least 10 years have passed since the Department of Defense Psychopharmacology Demonstration Project graduated its first class of psychologists. All graduates of that program were credentialed to prescribe and the program received promising external reviews and audits. The profession has since moved well beyond the initial question, "Can and should psychologists prescribe?" posed over two decades ago. A number of professional schools and training institutions have implemented postdoctoral psychopharmacology training programs and over 20 states are actively pursuing legislative agendas. Given recent initiatives to provide health psychology services within the primary care arena, the authors introduce a new role in the scope of psychology's prescribing activities. They propose that psychopharmacological agents are not the only medications psychologists should be trained to prescribe and psychopharmacology training should include course work and supervision related to treatment within a primary care patient setting in addition to a traditional psychiatric one. The authors provide the rationale for primary care clinical health psychology training as the appropriate mechanism for psychopharmacology education and practice. Public health needs and epidemiological data provide the rationale for health psychologists additionally prescribing non-psychopharmacological agents. © 2006 Wiley Periodicals, Inc. J Clin Psychol 62: 1213,1220, 2006. [source] Treatment of Highly Contaminated Groundwater: A SITE Demonstration ProjectREMEDIATION, Issue 3 2001Daniel Sullivan From September through November 1994, the U.S. Environmental Protection Agency (EPA) conducted a field demonstration of the remediation of highly contaminated groundwater at the Nascolite Superfund site located in Millville, New Jersey. Besides high concentrations of the major contaminant, methyl methacrylate (MMA), the groundwater also contained small amounts of volatile and semivolatile organic compounds. ZenoGem® technology, an integrated bioreactor and ultrafiltration membrane system, was employed for this demonstration project. Approximately 30,000 gallons of groundwater containing MMA in concentrations of 567 to 9,500 milligrams per liter (mg/L) and chemical oxygen demand (COD) values ranging from 1,490 to 19,600 mg/L was treated. The demonstration focused on the system's ability to remove MMA and reduce COD from the groundwater. Results of the three-month demonstration showed that average MMA and COD removal efficiencies were greater than 99.9 and 86.9, respectively. The total cost of treatment, depending on the duration of the project, is estimated to vary from $0.22 to $0.55 (in 1994 dollars) per gallon of groundwater treated. © 2001 John Wiley & Sons. [source] An evidence-based specialist breast nurse role in practice: a multicentre implementation studyEUROPEAN JOURNAL OF CANCER CARE, Issue 1 2003National breast cancer centre's specialist breast nurse project team The objective of this study was to examine the feasibility, implementation, acceptability and impact of an evidence-based specialist breast care nurse (SBN) model of care in Australia. Primary data were collected from four diverse Australian breast cancer treatment centres over a 12-month period. The design was a multicentre demonstration project. Information about the provision of care and patient needs was collected through prospective logs. Structured interviews were conducted with women who received the SBN intervention (N = 167) and with a control group of women treated prior to the intervention period (N = 133). Health professionals (N = 47) were interviewed about their experience of the SBN. Almost all women had contact with an SBN at five scheduled consultations and 67% of women in the intervention group requested at least one additional consultation with the SBN. Women in the intervention group were more likely to receive hospital fact sheets and to be told about and participate in clinical trials. Ninety-eight per cent of women reported that the availability of an SBN would affect their choice of hospital, with 48% indicating that they would recommend only a hospital with a SBN available. Health professionals reported that SBNs improved continuity of care, information and support for the women, and resulted in more appropriate referrals and use of the time of other members of the team. In conclusion, the SBN model is feasible and acceptable within diverse Australian treatment centres; there is evidence that some aspects of care were improved by the SBN. [source] Graduate Medical Education Downsizing: Perceived Effects of Participating in the HCFA Demonstration Project in New York StateACADEMIC EMERGENCY MEDICINE, Issue 2 2001Linda L. Spillance MD Abstract. Objective: Financial support for graduate medical education (GME) is shrinking nationally as Medicare cuts GME funds. Thirty-nine hospitals in New York State (NYS) voluntarily participated in a Health Care Financing Administration demonstration project (HCFADP),the goal of which was to reduce total residency training positions by 4-5%/year over a five-year period, while increasing primary care positions. The objective of this study was to determine the effect of downsizing on emergency department (ED) staffing and emergency medicine (EM) residency training. Methods: Structured interviews and surveys of NYS program directors (PDs) were conducted in October,December 1999. Simple frequencies are reported. Results: One hundred percent of 17 PDs completed the interviews and seven of 12 participants in the HCFADP returned surveys. Twelve of 17 programs participated in HCFADP and two programs downsized outside HCFADP. Seven of 12 participants lost EM positions. Six of 12 programs were forced to exclude outside residents from rotating in their ED, leading to a need for one participating program and one non-participating program to find alternative sites for trauma. Five of 12 institutions provided resident staffing data, reporting a reduction in ED resident coverage in year 1 of the project of 9-40%. Programs compensated by increasing the number of shifts worked (4/12), increasing shift length (1/12), decreasing pediatric ED shifts (1/12), decreasing elective or research time (2/12), and decreasing off-service rotations (4/12). Six departments hired physician assistants or nurse practitioners, two hired faculty, and two hired resident moonlighters. Six of 12 programs withdrew from HCFADP and returned to previous resident numbers. Eight of 12 PDs thought that they had decreased time for clinical teaching. Conclusions: A 4-5% reduction in residency positions was associated with a marked reduction in ED resident staffing and EM residency curriculum changes. [source] The Public/Private Partnership behind the Cash and Counseling Demonstration and Evaluation: Its Origins, Challenges, and Unresolved IssuesHEALTH SERVICES RESEARCH, Issue 1p2 2007James R. Knickman Objective. To discuss why and how the Cash and Counseling Demonstration came to be designed, implemented, and evaluated through a partnership between the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Robert Wood Johnson Foundation (RWJF). Principal Findings. This public/private partnership was created by two colleagues who were motivated by the need for funding to conduct a large-scale demonstration and evaluation, the prestige that both organizations brought to the project, the ability to draw on both organizations' experience and expertise, and the potential to maximize flexibility in the design and implementation of the demonstration. The partnership, which has lasted over a decade and has supported two generations of Cash and Counseling programs, overcame several challenges including getting approval for the project through their respective bureaucracies, managing the decision making process and the ongoing program across the two organizations, dealing with leadership and staff turnover, and reaching consensus on how to apportion credit for the success of the program. Several unresolved issues remain, including how the program gets operationalized within each state, how case management is addressed within the context of a consumer-directed model like Cash and Counseling, how quality is assured in this type of program, and how the Internal Revenue Service views and treats Cash and Counseling and other consumer-directed programs. Conclusion. This public/private partnership is an illustration of how public dollars can be leveraged effectively to examine a pressing policy issue and to produce information that can be translated into better policy and practice. The ASPE/RWJF collaboration made it possible to develop, test, and expand a policy-oriented demonstration project that has become a pivotal strategy in most states' efforts to build their home and community-based service systems. [source] A judicial,mental health partnership to heal young children in juvenile courtINFANT MENTAL HEALTH JOURNAL, Issue 1 2008Judge Cindy Lederman In this article, we describe the background and issues to be addressed related to dependent children in juvenile court. In an important effort to systematically examine developmental functioning and treatment needs in maltreated and violence-exposed young children, the Prevention and Evaluation of Early Neglect and Trauma (PREVENT) initiative of the Dependency Court Intervention Program for Family Violence, a national demonstration project in the Miami-Dade Juvenile Court, developed a program to evaluate all infants, toddlers, and preschoolers who are adjudicated dependent by the court. The goal of the intervention is to raise awareness of the needs of infants and toddlers in juvenile court and to work toward healing the child. The PREVENT program involved the evolution of a judicial,mental health partnership designed to assist the court in making more informed decisions about the best interest of the child by adding scientific knowledge about development, prevention, intervention, evaluation, and treatment. The outcome of the partnership and multidisciplinary approach is illustrated through presenting a case vignette of a mother and baby showing the challenges and strengths of intervention. Finally, we consider overall outcomes of the intervention and directions for the future. [source] Development and Validation of Quality Indicators for Dementia Diagnosis and Management in a Primary Care SettingJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2010Marieke Perry MD OBJECTIVES: To construct a set of quality indicators (QIs) for dementia diagnosis and management in a primary care setting. DESIGN: RAND modified Delphi method, including a postal survey, a stakeholders consensus meeting, a scientific expert consensus meeting, and a demonstration project. SETTING: Primary care. PARTICIPANTS: General practitioners (GPs), primary care nurses (PCNs), and informal caregivers (ICs) in postal survey and stakeholders consensus meeting. Eight national dementia experts in scientific consensus meeting. Thirteen GPs in the demonstration project. MEASUREMENTS: Mean face validity and feasibility scores. Compliance rates using GPs' electronic medical record data. RESULTS: The initial set consisted of 31 QIs. Most indicators showed moderate or good face validity and feasibility scores. Consensus panels reduced the preliminary set used in the demonstration project to 24 QIs. The overall compliance to the QIs was 45.3%. Discriminative validity of the set was good; significant differences in adherence were found between GPs with high and low levels of patients aged 65 and older in their practice, with and without PCNs, and with positive and negative attitudes toward dementia (all P<.05). Based on the demonstration project, one QI was excluded. The final set consisted of 23 QIs; 15 QIs contained innovative quality criteria on collaboration between GPs and PCNs, referral criteria, and assessment of caregivers' needs. CONCLUSION: This new set of dementia QIs is feasible, reliable, and valid and can be used to improve primary dementia care. Because of the innovative quality criteria, the set is complementary to the existing dementia QIs. [source] Accessing rural populations: role of the community pharmacist in a breast and cervical cancer screening programmeJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2007Timothy R. McGuire Pharm.D. FCCP Abstract Rationale, Community pharmacists are one of the most frequently visited health care providers in the USA. The article describes a demonstration project which used community pharmacists to educate and enrol low to moderate income and medically under-served women into a statewide breast and cervical cancer screening programme. Methods, The Nebraska Department of Health programme entitled, ,Every Woman Matters', funded through the Centers of Disease Control and Prevention, provided no cost or low cost mammography and pap smears to eligible women. Patient enrolment packets were distributed to 91 pharmacies expressing an initial interest in participating. These were reduced to 28 pharmacies based on their commitment level during the initial 3 months of the study. Results, One hundred and fourteen patient referrals were generated from the 28 network pharmacies; two from pharmacies in urban areas, and 112 referrals from rural sites. All referrals were from the 22 independently owned pharmacies in the study. Conclusions, Results suggest that the use of independent community pharmacies in the rural setting can be an effective method of recruiting women into public health programmes. [source] Visual inspection with acetic acid test qualities in a secondary settingJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2008Bandit Chumworathayi Abstract Aim:, To evaluate the visual inspection using acetic acid (VIA) test qualities in a secondary (follow-up) setting, 1 year after cryotherapy treatment performed as part of the Safety, Acceptability and Feasibility demonstration project designed to evaluate the safety, acceptability and feasibility of VIA. An immediate offer of cryotherapy was made to those who test positive and are eligible for treatment. Methods:, At 1 year after cryotherapy, 648 women received both a secondary (follow-up) VIA test by nurse-providers, and colposcopy with biopsy, if indicated, by trained physician colposcopists at a referral hospital. All pathologic specimens were sent for examination by a single pathologist. Results:, VIA nurse-providers assessed 42 of the 648 women (6.5%) referred as abnormal (i.e. they tested positive or were suspected of having cancer). Among the 42, the final colposcopic-based diagnosis was HSIL or higher in three cases (7.1%), of which two were HSIL and one was adenocarcinoma. Of the 606 VIA negative women, the colposcopic-based diagnosis was HSIL in only two cases (0.3%). Conclusions:, The VIA test qualities in this setting were: a positive rate of 6.5%, a sensitivity of 60%, a specificity of 93.9%, a positive predictive value of 7.1%, a negative predictive value of 99.7% and an accuracy of 93.7%. These results are comparable to those of Pap smear in most settings. [source] Problem-based Learning in Undergraduate Dental Education: Faculty Development at the University of Southern California School of DentistryJOURNAL OF PROSTHODONTICS, Issue 5 2007Timothy R. Saunders DDS The University of Southern California School of Dentistry (USCSD) seeks to educate oral health professionals with a balanced curriculum covering health promotion, risk assessment and disease prevention, diagnostics, treatments, and therapeutics. Based on critical analyses of a 5-year educational demonstration project, the USCSD proposed to use problem-based learning (PBL) to achieve its goals. Among the many changes required to convert a traditional dental educational curriculum to PBL, none is more important than that of faculty development. To achieve this, the USCSD Curriculum Subcommittee on Faculty Development, Mentoring, and Evaluation has designed and implemented a series of workshops to train its faculty as facilitators. There are four Core Skills Workshops: PBL Process Workshop, Facilitation of Learning Workshop, Student Assessment and Feedback Workshop, and PBL in the Clinical Environment. [source] Building a Partnership to Evaluate School-Linked Health Services: The Cincinnati School Health Demonstration ProjectJOURNAL OF SCHOOL HEALTH, Issue 10 2005Barbara L. Rose Partners from the Cincinnati Health Department, Cincinnati Public Schools, Cincinnati Children's Hospital Medical Center, and The Health Foundation of Greater Cincinnati wanted to determine if levels of school-linked care made a difference in student quality of life, school connectedness, attendance, emergency department use, and volume of referrals to health care specialists. School nurses, principals and school staff, parents and students, upper-level managers, and health service researchers worked together over a 2.5-year period to learn about and use new technology to collect information on student health, well-being, and outcome measures. Varying levels of school health care intervention models were instituted and evaluated. A standard model of care was compared with 2 models of enhanced care and service. The information collected from students, parents, nurses, and the school system provided a rich database on the health of urban children. School facilities, staffing, and computer technology, relationship building among stakeholders, extensive communication, and high student mobility were factors that influenced success and findings of the project. Funding for district-wide computerization and addition of school health staff was not secured by the end of the demonstration project; however, relationships among the partners endured and paved the way for future collaborations designed to better serve urban school children in Cincinnati. (J Sch Health. 2005;75(10):363-369) [source] The RWJF Reclaiming Futures Initiative: Improving Substance Abuse Interventions for Justice-Involved YouthsJUVENILE AND FAMILY COURT JOURNAL, Issue 4 2006LAURA BURNEY NISSEN ABSTRACT Juvenile justice systems in the United States do not always respond effectively to substance abuse problems among young offenders. In 2002, the Robert Wood Johnson Foundation launched a 10-community demonstration project to address this problem. Reclaiming Futures (RF) relies on community partnerships to improve treatment quality, strengthen local leadership, expand inter-organizational collaboration, and create systems of shared performance management. The initial findings of a cross-site evaluation suggest that Reclaiming Futures is yielding important and positive change. Bi-annual surveys of key informants measure the quality and integration of juvenile justice and substance abuse treatment systems in each community. Of 13 indices measured by the surveys, 11 showed significant improvements between 2003 and 2005. [source] Potential high temperature corrosion problems due to co-firing of biomass and fossil fuelsMATERIALS AND CORROSION/WERKSTOFFE UND KORROSION, Issue 10 2008M. Montgomery Abstract Over the past few years, considerable high temperature corrosion problems have been encountered when firing biomass in power plants due to the high content of potassium chloride in the deposits. Therefore, to combat chloride corrosion problems co-firing of biomass with a fossil fuel has been undertaken. This results in potassium chloride being converted to potassium sulphate in the combustion chamber and it is sulphate rich deposits that are deposited on the vulnerable metallic surfaces such as high temperature superheaters. Although this removes the problem of chloride corrosion, other corrosion mechanisms appear such as sulphidation and hot corrosion due to sulphate deposits. At Studstrup power plant Unit 4, based on trials with exposure times of 3000 h using 0,20% straw co-firing with coal, the plant now runs with a fuel mix of 10% straw,+,coal. Based on results from a 3 years exposure in this environment, the internal sulphidation is much more significant than that revealed in the demonstration project. Avedøre 2 main boiler is fuelled with wood pellets,+,heavy fuel oil,+,gas. Some reaction products resulting from the presence of vanadium compounds in the heavy oil were detected, i.e. iron vanadates. However, the most significant corrosion attack was sulphidation attack at the grain boundaries of 18-8 steel after 3 years exposure. The corrosion mechanisms and corrosion rates are compared with biomass firing and coal firing. Potential corrosion problems due to co-firing biomass and fossil fuels are discussed. [source] Active capping demonstration in the Anacostia river, Washington, D.C.REMEDIATION, Issue 1 2006Danny Reible An active capping demonstration project in Washington, D.C., is testing the ability to place sequestering agents on contaminated sediments using conventional equipment and evaluating their subsequent effectiveness relative to conventional passive sand sediment caps. Selected active capping materials include: (1) AquaBlokTM, a clay material for permeability control; (2) apatite, a phosphate mineral for metals control; (3) coke, an organic sequestration agent; and (4) sand material for a control cap. All of the materials, except coke, were placed in 8,000-ft test plots by a conventional clamshell method during March and April 2004. Coke was placed as a 1.25-cm layer in a laminated mat due to concerns related to settling of the material. Postcap sampling and analysis were conducted during the first, sixth, and eighteenth months after placement. Although postcap sampling is expected to continue for at least an additional 24 months, this article summarizes the results of the demonstration project and postcap sampling efforts up to 18 months. Conventional clamshell placement was found to be effective for placing relatively thin (six-inch) layers of active material. The viability of placing high-value or difficult-to-place material in a controlled manner was successfully demonstrated with the laminated mat. Postcap monitoring indicates that all cap materials effectively isolated contaminants, but it is not yet possible to differentiate between conventional sand and active cap layer performance. Monitoring of the permeability control layer indicated effective reductions in groundwater seepage rates through the cap, but also showed the potential for gas accumulation and irregular release. All of the cap materials show deposition of new contaminated sediment onto the surface of the caps, illustrating the importance of source control in maintaining sediment quality. © 2006 Wiley Periodicals, Inc. [source] Treatment of Highly Contaminated Groundwater: A SITE Demonstration ProjectREMEDIATION, Issue 3 2001Daniel Sullivan From September through November 1994, the U.S. Environmental Protection Agency (EPA) conducted a field demonstration of the remediation of highly contaminated groundwater at the Nascolite Superfund site located in Millville, New Jersey. Besides high concentrations of the major contaminant, methyl methacrylate (MMA), the groundwater also contained small amounts of volatile and semivolatile organic compounds. ZenoGem® technology, an integrated bioreactor and ultrafiltration membrane system, was employed for this demonstration project. Approximately 30,000 gallons of groundwater containing MMA in concentrations of 567 to 9,500 milligrams per liter (mg/L) and chemical oxygen demand (COD) values ranging from 1,490 to 19,600 mg/L was treated. The demonstration focused on the system's ability to remove MMA and reduce COD from the groundwater. Results of the three-month demonstration showed that average MMA and COD removal efficiencies were greater than 99.9 and 86.9, respectively. The total cost of treatment, depending on the duration of the project, is estimated to vary from $0.22 to $0.55 (in 1994 dollars) per gallon of groundwater treated. © 2001 John Wiley & Sons. [source] Healthy aging demonstration project: Nurse coaching for behavior change in older adults,RESEARCH IN NURSING & HEALTH, Issue 3 2005Jill A. Bennett Abstract The Healthy Aging Project (HAP) tested nurse coaching as a method to support healthy behavior change in older adults. The sample included 111 individuals randomized to a nurse coaching group or usual-care control group. Participants in the intervention group chose the health behaviors they wanted to change and received coaching by nurses in a single in-person session followed by telephone calls or email contact for 6 months. Nurses were trained in motivational interviewing (MI). The intervention group had significantly less illness intrusiveness and health distress than the control group at 6 months, although it is not known whether these health outcomes resulted from behavior changes. This clinical demonstration project showed that nurse-delivered MI, primarily using the telephone and email, is a feasible method to discuss behavioral change with older adults. However, future clinical trials will be needed to evaluate the efficacy of nurse-delivered MI on actual behavioral changes in older adults. © 2005 Wiley Periodicals, Inc. Res Nurs Health 28: 187,197, 2005 [source] Alternative cervical cancer prevention in low-resource settings: Experiences of visual inspection by acetic acid with single-visit approach in the first five provinces of ThailandAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2007Buncha PALANUWONG Abstract Background:, After the confirmation of its safety, acceptability and feasibility in a cervical cancer prevention demonstration project in 2002, a visual inspection by acetic acid (VIA) followed by an effective treatment using cryotherapy as a single-visit approach (SVA) was recently introduced in five provinces having low Pap smear screening rates, in Thailand. The effectiveness of a screening program is usually associated with a high level of coverage; however, in low-resource settings such a high coverage is still hard to attain by the conventional Pap smear approach. Aims:, To evaluate whether VIA/SVA can increase women's access to the prevention services in low-resource provinces of Thailand. Methods:, A cross-sectional study was conducted by analysing electronic screening records of the provinces. A ,2 test was used in the comparisons of screening coverage between the year before and the first year of VIA/SVA implementation during 1998,2005. Results:, This comparative study, which included 88 554 screening visits totally, shows a significant increase in the screening coverage of five provinces after the VIA/SVA implementation (P < 0.001). As a result of the large substitution of VIA/SVA for Pap smears, the costs of screening were lowered by as much as $US362 300 (66.8%) in the first year. Conclusion:, VIA/SVA has provided good screening coverage and lowered the financial burden in five low-resource provinces of Thailand. Therefore, it is promisingly competitive as a potential alternative means of cervical cancer prevention in low-resource areas. [source] Single Room Maternity Care and Client SatisfactionBIRTH, Issue 4 2000Patricia A Janssen MPH Background:Single room maternity care is the provision of intrapartum and postpartum care in a single room. It promotes a philosophy of family centered care in which one nurse cares for the family consistently throughout the intrapartum and postpartum periods. At B.C. Women's Hospital, a tertiary level obstetric teaching hospital in Vancouver, British Columbia, a seven-bed, single room maternity care unit was developed and opened as a demonstration project. As part of the evaluation of this unit, client satisfaction was compared between women enrolled in single room maternity care and those in a traditional setting.Method:The study group included 205 women who were admitted to the single room maternity care unit after meeting the low-risk criteria. Their responses on a satisfaction survey were compared with those of a historical comparison group of 221 women meeting the same eligibility criteria who were identified through chart audits 3 months before the single room maternity care unit was opened. A second, concurrent comparison group comprised 104 women who also met eligibility criteria.Results:Study group women were more satisfied than comparison groups in all areas evaluated, including provision of information and support, physical environment, nursing care, patient education, assistance with infant feeding, respect for privacy, and preparation for discharge.Conclusions:Single room maternity care was associated with a significant improvement in client satisfaction because of many factors, including the physical setting itself, avoidance of transfers, and improved continuity of nursing care. [source] TURNING OFFENDERS INTO RESPONSIBLE PARENTS AND CHILD SUPPORT PAYERS,FAMILY COURT REVIEW, Issue 3 2005Esther Ann Griswold This article describes four demonstration projects that strive to promote responsible behavior with respect to parenting, child support payment, and employment among incarcerated and paroled parents with child support obligations. These projects, conducted in Colorado, Illinois, Massachusetts, and Texas, with support from the federal Office of Child Support Enforcement and evaluated by the Center for Policy Research, led to a number of common outcomes and lessons. The projects revealed that inmates want help with child support, parenting, and employment and that prisons can be effective settings in which to conduct such interventions. Family reintegration programs were popular with inmates and may have helped to avoid the rupture of parent,child relationships commonly associated with incarceration. Although employment is the key to child support payment following release, rates of postrelease employment and earnings at all project sites were low and the employment programs were of limited utility in helping released offenders find jobs. Agencies dealing with child support, employment, and criminal justice need to adopt more effective policies with incarcerated parents including transitional job programs that guarantee immediate, subsidized employment upon release, child support guidelines that adjust for low earnings, and better training and education opportunities during incarceration. [source] Role of the Clinical Breast Examination in Breast Cancer ScreeningJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2001Does This Patient Have Breast Cancer? QUESTION: The authors, in an article for the JAMA section on the rational clinical examination, consider the evidence on whether and how to use clinical breast examination as a cancer screening technique. BACKGROUND: Breast cancer is a common disease, particularly in older women. The authors note that by age 70 the annual incidence of breast cancer is one in 200 women. Breast cancer survival is strongly influenced by the stage of the disease at the time of diagnosis. As a result, it is important to consider how best to screen for this disease. In recent years there has been considerable attention in the clinical literature and in the popular media paid to the screening strategies of breast self-examination and of screening mammography, but somewhat less to the potential role of the breast examination by the healthcare provider. In actual clinical practice, the same woman may be the recipient of any, none, or all of these screening modalities. The best way to combine these screening strategies, particularly in the case of the older woman, remains a subject of some uncertainty and controversy. DATA SOURCES: Data were obtained from a MEDLINE search of the English-language literature for 1966 through 1997 and additional articles as identified by the authors. STUDY SELECTION CRITERIA: In their evaluation of the effectiveness of clinical breast examination, the authors included both controlled trials and case-controlled studies in which clinical breast examination was used as a component of the screening. Study of breast examination technique considered both clinical studies and studies using silicone breast models. DATA EXTRACTION: The combined data from the trials included information on approximately 200,000 women who received a breast cancer screening intervention (mammography and/or clinical breast examination). However, none of the studies made the direct comparison of a group receiving clinical breast examination as a sole intervention with a control group that did not receive any screening. Data on the utility of clinical breast examination were partially derived from studies where that screening modality was used in combination with mammography. MAIN RESULTS: A number of trials of cancer screening have demonstrated a reduction in mortality from the use of mammography and clinical breast examination as combined screening strategies compared with no screening, with the inference that the reduction in mortality comes from the earlier detection of breast cancer. The percentage of the detected cancers that are detected in the trials by clinical breast examination despite having been missed on mammography varies across the trials from a low of 3% of the detected cancers to a high of 45%. It is speculative whether the marginal contribution of clinical breast examination to the mortality reduction in these screening trials corresponds to the percentage of cancers detected by clinical breast examination alone. In most of the clinical trials, the technique of breast examination reportedly was not well described. It is unclear therefore how much the technique of breast examination used varied within and among the clinical trials. Data from studies using examinations of breast models made of silicone demonstrated that test performance accuracy correlated with a lengthier breast examination, better breast examination technique, and perhaps with examiner experience. The report includes data from six comparator studies and from two demonstration projects. Of the six comparator studies, four compared a screened population with an unscreened population and two compared different intensities of screening strategies. None of the eight clinical trials was directed to a geriatric population and in fact older women were excluded by upper age entry criteria from the six comparator studies. (The upper age limit for study entry in the six comparator studies varied from 49 to 64.) CONCLUSION: The authors drew on the pooled results of these eight studies to conclude that clinical breast examination has a sensitivity of 54% (95% confidence interval, 48.3,59.8) and a specificity of 94% (95% confidence interval, 90.2,96.9). The authors conclude that screening clinical breast examination should be done for women age older than 40. [source] Dietary interventions in Finland, Norway and Sweden: nutrition policies and strategiesJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 2 2002G. Roos Aims To describe the organization and implementation of nutrition policies, and examine intervention strategies for dietary change in three Scandinavian countries. Methods Descriptions of nutrition policies and dietary intervention strategies are based on published nutrition policy research and reports. Results All countries studied have adopted formal nutrition policies. Norway issued its first white paper in 1976, the Finnish National Nutrition Council published an action plan in 1989, and the Swedish Government issued an official action plan in 1995. Norway has a centralized National Nutrition Council with a permanent administration whereas the responsibilities and administration are more spread out between several authorities and groups in Finland and Sweden. Amongst the dietary intervention strategies employed, a Norwegian nutrition campaign, symbol labelling of foods in Sweden, the community-based North Karelia Project in Finland, and mass catering in Finland and Sweden have been selected as potentially transferable. Conclusions Policy documents serve as guidelines for activities and assist in achieving dietary targets. A responsible administrative body with advice from a standing expert committee is valuable for implementation. Guidelines, recommendations or voluntary labelling standards can be incentives to product development and changes to food production. Regional demonstration projects may also encourage action and collaboration. [source] The use of Geographic Information Systems in climatology and meteorology: COST 719METEOROLOGICAL APPLICATIONS, Issue 1 2005Izabela Dyras The COST Action 719 started in 2001 and presently 20 European countries are participating. The main objectives of the Action are to establish interfaces between GIS and meteorological data, assess the availability, contents and accessibility of meteorological and climatological data sets and encourage and foster European co-operation. The tasks are carried out within three working groups concentrated on issues such as data access and availability, methods of spatial interpolation and developing recommendations for standardised GIS applications. The applications that have been adopted mainly focus on three parameters, i.e. precipitation, temperature and energy balance for which three demonstration projects have been formulated. It is expected that the Action will result in recommendations for better and more cost-effective production of state-of-the-art meteorological and climatological information. Also an improvement of the co-operation between European countries in the application of GIS in the field of meteorology, climatology and environmental sciences should be achieved together with better-trained personnel within the operational and scientific divisions of national meteorological services. Additionally, the development of a visualisation system for climate data sets for internet applications is under preparation. This paper provides information concerning the work in progress on the demonstration projects made within COST 719. Copyright © 2005 Royal Meteorological Society. [source] Prenatal screening for serious congenital heart defects using nuchal translucency: a meta-analysisPRENATAL DIAGNOSIS, Issue 12 2008Nicholas J. Wald Abstract Objectives To assess the performance of nuchal translucency (NT) measurements in screening for congenital heart defects (CHD) which would benefit from prenatal detection. Methods A literature search was conducted of studies published prior to August 2007 of CHD and NT measurements in fetuses without chromosome defects. From this, data on 159 pregnancies were obtained. Fetuses with CHD that would benefit from prenatal detection were identified and their NT measurements were compared with NT measurements in 29 776 unaffected fetuses without Down syndrome from the Serum Urine and Ultrasound Screening Study (SURUSS) trial to determine the screening performance of NT measurements. Results In all 67 fetuses with CHD were identified as potentially likely to benefit from prenatal detection. Using NT measurements, the estimated detection rate (DR) for a 5% false-positive rate (FPR) was 52% (95% CI: 42,71). Conclusion Prenatal screening for CHD using NT measurements is likely to be effective, and given that NT measurement is already in place as part of prenatal screening for Down syndrome; this is an ideal time to set up demonstration projects to validate these results. Copyright © 2008 John Wiley & Sons, Ltd. [source] Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional StaffTHE JOURNAL OF RURAL HEALTH, Issue 3 2005Keith J. Mueller PhD ABSTRACT: Sweeping changes to the Medicare program embodied in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), including a new prescription drug benefit, changes in payment policies, and reform of the Medicare managed-care program, have major implications for rural health care. The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in September 2004 to identify a set of researchable questions concerning the impact of the MMA on rural health care. This paper presents research questions in the following areas that staff identified as having the highest priority: access to health plans and pharmacy services, beneficiary outreach and enrollment, technology capacity, provider payment policy, and demonstration projects. [source] Is Rapid Organ Recovery a Good Idea?AMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2009An Exploratory Study of the Public's Knowledge, Attitudes In 2006, the Institute of Medicine (IOM) recommended demonstration projects on uncontrolled donation after cardiac death or rapid organ recovery (ROR). To investigate what the public thinks about key ethical and policy questions associated with ROR, 70 African-American, Caucasian and Latino community members in St. Louis, MO, participated in focus groups and completed surveys, before and after being educated about ROR. Before the focus group, most participants believed mistakenly that they could donate organs following an unexpected cardiac arrest (76%). After the focus group, 84% would want to donate organs after unexpected cardiac arrest; 81% would support organ cooling to enable this. The public generally supported organ cooling without family consent if the individual had joined the donor registry, but were mixed in their opinions about what should be done if they were not on the registry. African-American and Latino participants expressed greater fears than Caucasians that if they consented to organ donation, physicians might do less to save their life; however, support for ROR was not significantly lower in these subgroups. Although this study is exploratory, public support for ROR was present. We recommend that adequate consent processes and safeguards be established to foster trust and support for ROR. [source] | ||||||||||||||||||||||||||||||||||